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Recommended immunization schedule for children and adolescents age 7 through 18 years – United States, 2024 (for those who fall behind or start late, refer to UpToDate content related to the catch-up schedule)

Recommended immunization schedule for children and adolescents age 7 through 18 years – United States, 2024 (for those who fall behind or start late, refer to UpToDate content related to the catch-up schedule)

This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Academy of Physician Associates, and National Association of Pediatric Nurse Practitioners.
  • Consult relevant ACIP statements for detailed recommendations.
  • When a vaccine is not administered at the recommended age, administer at a subsequent visit.
  • Use combination vaccines instead of separate injections when appropriate.
  • Report clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) online at https://vaers.hhs.gov or by telephone, 800-822-7967.
  • Report suspected cases of reportable vaccine-preventable diseases to your state or local health department.
  • For information about precautions and contraindications, refer to https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
  • For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.

IIV4: quadrivalent inactivated influenza vaccine; LAIV4: quadrivalent live attenuated influenza vaccine; mIU: milli-international units; MMRV: combined measles, mumps, rubella and varicella; MMWR: Morbidity and Mortality Weekly Report; PCV13: 13-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PCV20; 20-valent pneumococcal conjugate vaccine; RIV4: anti-HBs: hepatitis B surface antibody.

* Adolescent vaccine age groups.

Tetanus and diphtheria toxoids, and acellular pertussis (Tdap) vaccination

(Minimum age: 11 years for routine vaccination; 7 years for catch-up vaccination)
  • Adolescents age 11 through 12 years: 1 dose Tdap.
  • Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27 through 36.
  • Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.
  • Wound management: See www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm for vaccination indications as part of wound management.

Δ Human papillomavirus (HPV) vaccination

(Minimum age: 9 years)
  • Routine vaccination:
    • HPV vaccination routinely recommended at age 11 through 12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated.
    • 2- or 3-dose series depending on age at initial vaccination:
      • Age 9 through 14 years at initial vaccination: 2-dose series at 0 and 6 to 12 months (minimum interval: 5 months; repeat dose if administered too soon).
      • Age 15 years or older at initial vaccination: 3-dose series at 0, 1 to 2 months, and 6 months (minimum intervals: dose 1 to dose 2: 4 weeks; dose 2 to dose 3: 12 weeks; dose 1 to dose 3: 5 months; repeat dose if administered too soon).
    • Interrupted schedules: If vaccination schedule is interrupted, the series does not need to be restarted.
    • No additional dose recommended after completing series with recommended dosing intervals.
  • Special situations:
    • Immunocompromising conditions, including HIV infection: 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
    • History of sexual abuse or assault: Start at age 9 years.
    • Pregnancy: Pregnancy testing not needed before vaccination. HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant.

Meningococcal serogroup A, C, W, Y (MenACWY) vaccination

(Minimum age: 2 months for MenACWY-CRM [Menveo]; 2 years for MenACWY-TT [MenQuadfi]); 10 years for MenACWY-TT/MenB-FHbp [Penbraya]
  • Routine vaccination:
    • 2-dose series at 11 through 12 years and 16 years.
  • Catch-up vaccination:
    • Age 13 through 15 years: 1 dose now and booster at age 16 through 18 years (minimum interval: 8 weeks)
    • Age 16 through 18 years: 1 dose
  • Special situations:
    • Refer to UpToDate content related to meningococcal vaccines and immunization in specific high-risk groups. High-risk conditions include anatomic or functional asplenia (including sickle cell disease); HIV infection; persistent complement component deficiency; complement inhibitor (eg, eculizumab, ravulizumab) use; travel to countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (refer to wwwnc.cdc.gov/travel); first-year college students who live in residential housing (if not previously vaccinated at age 16 years or older); and military recruits.
    • Menveo has two formulations: lyophilized and liquid. The liquid formulation should not be used before age 10 years.

§ Meningococcal serogroup B (MenB) vaccination

(Minimum age: 10 years for MenB-4C [Bexsero], MenB-FHbp [Trumenba], or MenACWY-TT/MenB-FHbp [Penbraya])
  • Healthy adolescents not at increased risk age 16 through 23 years (preferred age 16 through 18 years), particularly those about to attend college:
    • Bexsero: 2-dose series at least 1 month apart.
    • Trumenba: 2-dose series at least 6 months apart; if dose 2 is administered earlier than 6 months, administer a third dose at least 4 months after dose 2.
  • Special situations:
    • Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use:
      • Bexsero: 2-dose series at least 1 month apart.
      • Trumenba: 3-dose series at 0, 1 to 2, and 6 months (if dose 2 was administered at least 6 months after dose 1, dose 3 not needed; if dose 3 is administered earlier than 4 months after dose 2, a fourth dose should be administered at least 4 months after dose 3).
  • NOTE: Bexsero and Trumenba are not interchangeable; the same product should be used for all doses in a series.
  • For additional information, refer to UpToDate content on meningococcal vaccines and immunization in the specific high-risk group.

¥ COVID-19 vaccination

(Minimum age: 6 months (1vCOV-mRNA [Moderna and Pfizer-BioNTech vaccines], 12 years (1vCOV-aPS [Novavax vaccine])
  • Age 7 through 11 years:
    • Unvaccinated: 1 dose of updated (2023-2024 formula) Moderna or Pfizer-BioNTech vaccine.
    • Previously vaccinated with 1 or more doses of Moderna or Pfizer-BioNTech: 1 dose of updated (2023-2024 formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.
  • Age 12 through 18 years:
    • Unvaccinated: 1 dose of updated (2023-2024 formula) Moderna or Pfizer-BioNTech vaccine or 2-dose series of updated (2023-2024 formula) Novavax at 0 and 3 to 8 weeks.
    • Previously vaccinated with any COVID-19 vaccine(s): 1 dose of and updated (2023-2024 formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
  • Moderately or severely immunocompromised:
    • Age 7 through 11 years, unvaccinated: 3-dose series at 0, 4, and 8 weeks of updated (2023-2024 formula) Moderna or 3-dose series at 0, 3, and 7 weeks of updated (2023-2024 formula) Pfizer-BioNTech.
    • Age 7 through 11 years, previously vaccinated with:
      • 1 dose of Moderna: 2-dose series of updated (2023-2024 formula) Moderna at 0 and 4 weeks (minimum interval between previous dose and dose 1: 4 weeks).
      • 2 doses of Moderna: 1 dose of updated (2023-2024 formula) Moderna at least 4 weeks after most recent dose.
      • 3 or more doses of Moderna or Pfizer-BioNTech: 1 dose of updated (2023-2024 formula) Moderna or Pfizer-BioNTech at least 8 weeks after most recent dose.
      • 1 dose of Pfizer-BioNTech: 2-dose series of updated (2023-2024 formula) Pfizer-BioNTech at 0 and 4 weeks (minimum interval between previous dose and dose 1: 3 weeks).
      • 2 doses of Pfizer-BioNTech: 1 dose of 2023-2024 Pfizer-BioNTech at least 4 weeks after the most recent dose.
    • Age 12 through 18 years, unvaccinated:
      • 3-dose series of updated (2023-2024 formula) Moderna at 0, 4, and 8 weeks.
      • 3-dose series of updated (2023-2024 formula) Pfizer-BioNTech at 0, 3, and 7 weeks.
      • 2-dose series of updated (2023-2024 formula) Novavax at 0 and 3 weeks.
    • Age 12 through 18 years, previously vaccinated with:
      • 1 dose of any Moderna: 2-dose series of updated (2023-2024 formula) Moderna at 0 and 4 weeks (minimum interval between previous Moderna dose and dose 1: 4 weeks).
      • 2 doses of any Moderna: 1 dose of updated (2023-2024 formula) Moderna at least 4 weeks after the most recent dose.
      • 1 dose of any Pfizer-BioNTech: 2-dose series of updated (2023-2024 formula) Pfizer-BioNTech at 0 and 4 weeks (minimum interval between previous Pfizer-BioNTech dose and dose 1: 3 weeks).
      • 2 doses of any Pfizer-BioNTech: 1 dose of updated (2023-2024 formula) Pfizer-BioNTech at least 4 weeks after the most recent dose.
      • 3 or more doses of any Moderna or Pfizer-BioNTech: 1 dose of any updated (2023-2024 formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
      • 1 or more doses of Janssen or Novavax or with or without dose(s) of any original monovalent or bivalent COVID-19 vaccine: 1 dose of any updated (2023-2024 formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
  • For additional recommendations, Refer to www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html.
  • NOTE: Administer an age-appropriate vaccine product for each dose. Current COVID-19 schedule and dosage formulation available at www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines refer to www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

Influenza vaccination

(Minimum age: 6 months for inactivated influenza vaccine [IIV]; 2 years for live attenuated influenza vaccine [LAIV4]; 18 years for recombinant influenza vaccine [RIV4])
  • Use any influenza vaccine appropriate for age and health status annually (refer to UpToDate content on influenza vaccination in children and ACIP recommendations):
    • 2 doses, separated by at least 4 weeks, for children 7 through 8 years who have received fewer than 2 influenza vaccine doses before July 1, 2023, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2).
    • 1 dose for children age 7 years through 8 years who have received at least 2 influenza vaccine doses before July 1, 2023.
    • 1 dose for all persons age 9 years or older.
  • For the 2023-2024 season, refer to the 2023-2024 ACIP influenza vaccine recommendations.
  • For the 2024-2025 season, refer to the 2024-2025 ACIP influenza vaccine recommendations.

Pneumococcal vaccination

(Minimum age: 6 weeks for 15-valent, and 20-valent pneumococcal conjugate vaccine [PCV15, PCV20]; 2 years for 23-valent pneumococcal polysaccharide vaccine [PPSV23])
  • Special situations:
    • High-risk conditions: Refer to separate UpToDate content and ACIP recommendations for information on pneumococcal vaccination in children with high-risk conditions. High-risk conditions include functional or anatomic asplenia (eg, sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia or splenic dysfunction); congenital or acquired immunodeficiencies; HIV infection; nephrotic syndrome; chronic kidney disease; malignant neoplasms, leukemias, lymphomas, Hodgkin disease, multiple myeloma, and other diseases associated with treated with chemotherapy and/or radiation therapy; iatrogenic immunosuppression (eg, solid organ transplantation, long-term systemic glucocorticoids, tumor necrosis alpha inhibitors [eg, etanercept, infliximab], radiation therapy); cerebrospinal fluid leak; cochlear implant; chronic heart disease (particularly cyanotic congenital heart disease, cardiac failure, and cardiomyopathy); chronic lung disease (including moderate-to-severe persistent asthma); diabetes mellitus; and chronic liver disease.
    • Children with high-risk conditions should receive at least one dose of PCV20 or PPSV23.
    • When both PCV15 and PPSV23 are indicated, administer PCV15 first. PCV15 and PPSV23 should not be administered during the same visit.

** Haemophilus influenzae type b (Hib) vaccination

(Minimum age: 6 weeks)
  • Special situations:
    • Refer to UpToDate content related to Hib vaccination and immunization in the specific high-risk group and the ACIP recommendations. Special situations and high-risk groups include chemotherapy or radiation treatment, hematopoietic cell transplant, anatomic or functional asplenia (including sickle cell disease), elective splenectomy, HIV infection, immunoglobulin deficiency, and early component complement deficiency.

¶¶ Hepatitis A (HepA) vaccination

(Minimum age: 12 months for routine vaccination)
  • Catch-up vaccination:
    • Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).
    • Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
    • Adolescents age 18 years or older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or a 4-dose series (3 doses at 0, 7, and 21 to 30 days, followed by a booster dose at 12 months).
  • International travel: Persons traveling to or working in countries with high or intermediate endemic hepatitis A:
    • Unvaccinated age 12 months or older: Administer dose 1 as soon as travel is considered.

ΔΔ Hepatitis B (HepB) vaccination

(Minimum age: Birth)
  • Catch-up vaccination:
    • Unvaccinated persons should complete a 3-dose series at 0, 1 to 2, and 6 months.
    • Adolescents age 11 through 15 years may use an alternative 2-dose schedule, with at least 4 months between doses (adult formulation Recombivax HB only).
    • Adolescents 18 years or older may receive:
      • Heplisav-B: 2-dose series at least 4 weeks apart.
      • PreHevbrio: 3-dose series at 0, 1, and 6 months.
      • Combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 21 to 30 days, followed by a dose at 12 months).
  • Special situations:
    • Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
    • Postvaccination serology testing and revaccination (if anti-HBs <10 mIU/mL) is recommended for certain populations, including:
      • Persons who are predialysis or on maintenance dialysis.
      • Other immunocompromised persons.
    • For detailed revaccination recommendations, refer to www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.
  • NOTE: Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons.

◊◊ Inactivated poliovirus (IPV) vaccination

(Minimum age: 6 weeks)
  • A fourth dose of IPV is indicated if all previous doses were administered at <4 years OR if the third dose was administered <6 months after the second dose.
  • IPV is not routinely recommended for United States residents age 18 years or older.

§§ Measles, mumps, and rubella (MMR) vaccination

(Minimum age: 12 months for routine vaccination)
  • Catch-up vaccination:
    • Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart.
    • Partially vaccinated children and adolescents: 1 dose at least 4 weeks after the previous dose
    • The maximum age for use of MMRV vaccine is 12 years.
    • Minimum interval between MMRV doses: 3 months.
  • International travel:
    • Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart before departure.

¥¥ Varicella (VAR) vaccination

(Minimum age: 12 months)
  • Ensure persons 7 through 18 years without evidence of immunity (refer to MMWR Recomm Rep 2007; 56(RR04):1) have a 2-dose series.
    • Age 7 through 12 years: Routine interval: 3 months (a dose inadvertently administered after at least 4 weeks may be counted as valid).
    • Age 13 years or older: Routine interval: 4 to 8 weeks (minimum interval: 4 weeks).
    • The maximum age for use of MMRV is 12 years.

‡‡ Dengue vaccination

(Minimum age: 9 years)
  • Routine vaccination:
    • Age 9 through 16 years living in dengue endemic areas and have laboratory confirmation of previous dengue infection: 3-dose series administered at 0, 6, and 12 months.
    • Endemic areas include Puerto Rico, American Samoa, United States Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau. For updated guidance on dengue endemic areas and prevaccination laboratory testing refer to the ACIP recommendations and www.cdc.gov/dengue/vaccine/hcp/index.html.
    • Dengue vaccine should not be administered to children traveling to or visiting endemic dengue areas.

†† Mpox vaccination

(minimum age: 18 years [Jynneos])
  • At risk for mpox infection: 2-dose series, 28 days apart.
  • Risk factors include:
    • Persons who are gay, bisexual, men who have sex with men, transgender, and nonbinary who in the past 6 months have had:
      • A new diagnosis of at least 1 sexually transmitted infection.
      • More than 1 sex partner.
      • Sex at a commercial sex venue.
      • Sex in association with a large public event in a geographic area where mpox transmission is occurring.
    • Persons who are sexual partners of the persons described above.
    • Persons who anticipate experiencing any of the situations described above.

For more details, see www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/04-MPOX-Rao-508.pdf

Adapted from: Centers for Disease Control and Prevention. Immunization schedules. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (Accessed on November 29, 2023).
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